The correct answer is D. Rotator cuff tears are chronic use injuries most common in throwing athletes. The clinical symptoms are weakness and instability of the shoulder. An x-ray may show a subacromial spurring, a high-riding shoulder, or calcific tendonitis. Diagnosis is made by MRI of the shoulder. This is a non-emergent diagnosis and the imaging can be performed on an outpatient basis. Repair is made arthroscopically.
Advising the patient to rest and ice the shoulder (choice A) will help alleviate the immediate symptoms of pain. It will not, however, treat the underlying condition of a rotator cuff tear. Rest and ice are good for muscle sprains, but will not help torn tendons.
A CT scan of the shoulder (choice B) is not indicated in suspected cases of rotator cuff tears. A CT is good for evaluating the bones of the shoulder, but does not provide the resolution to evaluate the muscles and tendons of the shoulder.
An emergent MRI of the shoulder (choice C) is not indicated. Rotator cuff tears are chronic overuse injuries and do not require emergent diagnosis or repair. The MRI should be ordered on an outpatient basis.
Prescribing nonsteroidal antiinflammatory drugs (choice E) will help alleviate the immediate symptoms of pain. It will not, however, treat the underlying condition of a rotator cuff tear.
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